Histamine Intolerance (HIT) worth looking in to

There are many chronic conditions that still aren’t getting as much recognition as they warrant from the medical community. Some doctors question the reality of existence of these afflictions. One of those is Histamine Intolerance (HIT).

The condition presents itself more predominantly in persons with gastrointestinal disorders, and if you are an individual affected by it, you are in no doubt how real it is. Symptoms include diarrhea, headache, runny nose, watering eyes, itching, flushing, rash (hives, eczema), swelling of face/lips/hands, and more.

The diagnosis of Histamine Intolerance is more widely accepted in Europe. In 2012, the German Society for Allergology and Clinical Immunology accepted it but stated that the pathophysiology had yet to be determined. Hence the need for continuing research.

To gain a better understanding of histamine intolerance for readers of The Honest Migraine, I sought clarity and expert input from Dr. Amy Burkhart, one of only two physicians in the United States who is also a registered dietitian and trained in integrative medicine.

Histamine intolerance (HIT) is an emerging topic. Over the past 10 years, research on the topic has vastly increased and justly so.

For a person with a histamine intolerance, essentially “the total amount of histamine in the body exceeds the rate at which histamine is broken down,” Burkhart explained. “Histamine has widespread effects throughout the body.”

There isn’t a test for histamine intolerance. It boils down to process of elimination.

In my own experience, I would say over the past decade intolerances have more readily become part of medical conversations. Whether that means they are more easily identified, accepted, or simply life altering – is for each to determine on their own.

Right off the bat, my curiosity was piqued in regards to the comparison of a person being lactose intolerant vs. histamine intolerant. Also, what’s really going on behind-the-scenes with both?

Similarities include that “they can both present with GI [gastrointestinal] symptoms and both of the enzymes involved with digesting the substances (DAO-histamine, Lactase-lactose) live in the villi of the intestine,” Burkhart explained.

There is currently no percentage available of the population that suffers from histamine intolerance.

Knowing that “lactose intolerance occurs due to a person’s inability to digest milk sugar lactose,” it has been documented that it can either be temporary or a life long struggle. Persons who are lactose intolerant tend to experience “gas, bloating, cramping, and diarrhea.”

With histamine intolerance, “symptoms tend to be more widespread and not solely isolated to the gastrointestinal tract,” however, there are exceptions to the rule, Burkhart said.

Reaction to histamine intolerance is not uniform. “Everyone has a different ‘set point,’” Burkhart stated. The range “could be minutes to hours. [And] if symptoms are happening immediately, it is imperative that the person is evaluated for actual allergies.”

The central nervous system is impacted by histamine. Most commonly, individuals experience “headaches, dizziness, brain fog, and sleep disturbances,” Burkhart said. Other symptoms can include “‘nerve-related’ symptoms such as tinnitus (ringing in the ears), numbness, tingling on the skin and muscle twitching.”

You’re probably curious if you should broach the subject of histamine intolerance with your doctor. Burkhart explained that before a histamine intolerance is diagnosed, “a lot of other conditions need to be ‘ruled out.’” If and when other conditions are ruled out and a person is experiencing “GI symptoms, headaches, rashes or any other histamine intolerance symptoms,” a conversation with your healthcare provider is recommended.

Some conditions that can “evoke thoughts of histamine intolerance are IBS (Irritable Bowel Syndrome), chronic urticaria (chronic hives), SIBO (small intestine bacterial overgrowth), Celiac disease and other underlying digestive disorders as they put someone at higher risk for histamine intolerance,” Burkhart said.


So how do genetics and other underlying health conditions play a role with histamine intolerance? Burkhart explains that “it appears that people with underlying digestive disorders such as Celiac disease, inflammatory bowel disease, and SIBO, are at increased risk.”

Food inevitably has a certain histamine content yet it’s extremely difficult to accurately measure the amounts due to the variables (processed, freshness, temperature).

Something simple like putting your dinner leftovers in the refrigerator at night to use as an easy lunch the next day can impact a person’s histamine intolerance. This is because histamine levels of food fluctuate when stored in the refrigerator compared to the freezer. As Burkhart explained, “When food ages, bacterial enzymes convert histidine (an amino acid in food) to histamine. With age and increased bacterial counts, this conversion rate increases.”

The continuing research into Histamine Intolerance is vital. Those suffering from chronic symptoms associated with it know how debilitating it can be.

Like the many other under-represented conditions I have discussed in The Honest Migraine, it’s time for medical professionals to be more open-minded about these conditions. While there may not be the amount of research money put into Histamine Intolerance as other conditions and diseases, it doesn’t make it less important or less “real.”

If you are suffering from these symptoms, please press forward, ask for the necessary tests to determine exactly what you are suffering from, so you can make positive progress. That’s what we have to do to live our best life! It’s up to us to keep asking questions and getting the most out of our medical care as possible.

Amy Burkhart, MD, RD, is also a board-certified emergency medical physician, with her practice located in Napa, CA.  

Coming next: Honesty can be intimidating, but empowering

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